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Debunking parents' stubborn fear of vaccines

By Amanda Mascarelli, special to The Washington Post

Posted:
09/04/2013 09:39:57 AM MDT

Child vaccination (Stock/Getty Images)

My introduction to anti-vaccine thinking came six years ago during a natural birth class. To our list of big decisions, the teacher added another — whether to go along with routine vaccinations, the first of which (hepatitis B) is typically given before the baby leaves the hospital.

For my husband and I, the decision was straightforward: We chose the standard, doctor-recommended vaccine schedule for all three of our children. But for some people, childhood vaccination is a fraught issue.

At a recent child's birthday party, for example, one father mentioned that he and his wife had opted out of vaccinating their children. They didn't feel comfortable with the mercury in vaccines, apparently referring to suspicion of its link to autism.

I was stumped. The preservative thimerosal, which contains a form of mercury called ethyl mercury, was removed from most vaccines (with exception to influenza vaccines) in the United States more than a decade ago and has long since been absolved of causing autism.

Thimerosal has been used as a preservative to prevent bacterial and fungal growth in certain multi-dose vaccines and other biological products since the 1930s. In the late 1990s, health officials began to grow increasingly aware of the dangers of mercury in fish and shellfish. The mercury found in fish is an entirely different form than what is in thimerosal. It's called methyl mercury; it grows more concentrated as it moves up the food chain and is neurotoxic in large amounts, especially to developing fetuses.

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But the seafood contamination issue led to concerns about the possibility of harm from the trace amount of mercury used in vaccines. "At that time — 1999 — there really wasn't sufficient scientific information to know about the differences between how ethyl mercury would act versus methyl mercury," says Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Texas. Still, even then, enough was known about the genetic basis of autism and the unique clinical syndrome caused by mercury poisoning to make any causal link between autism and thimerosal highly unlikely, he adds.

As a precaution, the Food and Drug Administration called for a review of the mercury content in food and drugs. Although there was no evidence of harm from the ethyl mercury in vaccines, the American Academy of Pediatrics and the U.S. Public Health Service acted pre-emptively to avoid any potential harm and to protect public trust; in 1999, these agencies issued a ban on the use of thimerosal in routine vaccinations given to infants and children. By the early 2000s, thimerosal had been removed from vaccines such as those for hepatitis B, diphtheria and tetanus toxoids and acellular pertussis (DTap), and haemophilus influenzae type B (Hib).

The ban did not apply to annual influenza vaccines; U.S. health organizations concluded that the benefits of the influenza vaccine far outweighed the low risk of harm from thimerosal.

But in part because the government moved so swiftly to remove the preservative from most vaccines, along with sensationalist media coverage and claims of vaccines being linked to autism — now disproved — the public's distrust of thimerosal grew in some circles, says Roger Baxter, co-director of the Kaiser Permanente Vaccine Study Center in Oakland, Calif. "There was never actually a problem with thimerosal," Baxter says. "It was all manufactured by rumor."

Numerous studies have looked at whether children who received mercury-containing vaccines had poorer outcomes or increased risk of autism or other disorders, and no causal link has been found.

Still, the controversy surrounding thimerosal helped buoy the anti-vaccine movement in the late '90s. About the same time, the movement began to focus on the potential links between the measles-mumps-rubella (MMR) vaccine and autism, spurred by the publication of a study — which was later retracted — that claimed that the MMR vaccine could cause autism. The paper was subsequently found to be fraudulent, and the author, Andrew Wakefield, a British doctor, lost his medical license.

In recent years, anti-vaccine proponents have begun to focus on the timing of vaccines, suggesting that too many vaccines too early in life can overload a child's immune system and cause autism.

"The good news here is that these are questions that can be answered by science, and science has answered them," says Alison Singer, president of the Autism Science Foundation, a research organization that helps fund research into the causes of autism. Pointing to the many papers that have explored and refuted the links between autism and thimerosal, the MMR vaccine, and vaccine timing, Singer says: "They're all showing the same thing — that vaccines do not result in an increase in the diagnosis rate of autism. The question is, 'Are you as a parent willing to believe what the data clearly say?' And the majority of parents are." Singer's daughter, who is now 16 years old, was diagnosed with autism at the age of 2.

Nevertheless, mercury should never be a reason not to vaccinate; it is easy to get your child fully vaccinated without exposing him or her to a mercury-containing preservative, says Neal Halsey, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health in Baltimore. For example, parents can request versions of the influenza vaccine that have no mercury, Halsey says.

The risks from vaccines are low, Halsey notes. About one per million doses can lead to a serious complication such as a severe allergic reaction."But it's at least a thousand times safer to give your child the vaccine than it is to let them be unvaccinated," he says.

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